Many women transitioning into the menopause request medical advice on ways to improve their quality of life and to relieve the symptoms associated with the menopausal transition. With concerns regarding the long-term use of estrogen replacement therapy, there has been interest in the use of non-hormonal strategies to manage these symptoms.

Last year we reported on the use of exercise and yoga to treat vasomotor symptoms (VMS). Sternfeld and colleagues reported no differences between exercise and usual activity in terms of VMS frequency or bother; however, the exercise group reported greater improvement in insomnia symptoms, subjective sleep quality, and depressive symptoms, although these differences were small. The results were similar in a study looking at the effects of yoga (Newton et al, 2013). There was no difference between exercise and yoga in terms of vasomotor symptoms; however, the women in the yoga group noted improvements in their sleep.

Rather than focusing on specific symptoms, a recent study focuses on how yoga and exercise affect quality of life in peri- and post-menopausal women. In this MsFLASH study, 355 peri- and postmenopausal women, 40-62 years old, were assigned randomly to yoga (n = 107), exercise (n = 106), or usual activity (n = 142). The groups consisted of the following types of activity: (1) weekly 90-minute yoga classes with daily at-home practice, (2) individualized facility-based aerobic exercise training 3 times/week, and (3) usual activity.

The outcomes were assessed with the Menopausal Quality of Life Questionnaire (MENQOL), total and domain scores (assessing vasomotor symptoms, psychosocial, physical and sexual domains). The mean baseline total MENQOL score was 3.8 (range, 1-8 from better to worse) with no differences between the groups.

For yoga compared to usual activity, baseline to 12-week improvements were seen on the MENQOL total score of -0.3, the vasomotor symptom domain (P = .02), and the sexuality domain (P = .03); however, the improvements were relatively small. For women in the exercise group, there were no differences from baseline to week 12, compared with control subjects.

While the data on yoga and exercise are less than impressive in this study, it doesn’t feel quite right to issue purely evidence-based recommendations to our patients and to tell menopausal women that exercise and yoga are likely to have minimal benefits. The authors note that yoga and exercise may benefit some groups of women more than others. They also note that 12 weeks might not be enough time to see significant differences in quality of life. While yoga and exercise may not significantly improve quality of life as assessed in this study, it is important to note that other studies have demonstrated the positive effects of physical exercise on mood, sleep, weight and fitness level.

Ruta Nonacs, MD PhD

Newton KM, Reed SD, Guthrie KA, et al. Efficacy of yoga for vasomotor symptoms: a randomized controlled trial. Menopause. 2013 Sep 16. [Epub ahead of print]

Reed SD, Guthrie KA, Newton KM, et al. Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements. Am J Obstet Gynecol. 2014 Mar;210(3):244.e1-11.

Sternfeld B, Guthrie KA, Ensrud KE, et al. Efficacy of exercise for menopausal symptoms: a randomized controlled trial. Menopause. 2013 Aug 12. [Epub ahead of print]